Chronic pain is a major healthcare problem worldwide, and particularly in Asia Pacific where it has long been neglected due to a lack of understanding and awareness among the general public, health policy makers, and healthcare professionals. Chronic pain can drastically limit the quality of life and well-being of sufferers and places a considerable burden on healthcare systems. With chronic pain currently affecting one in five adults worldwide, it is poised to become one of the most critical healthcare issues in the region as the population ages and the prevalence of related conditions continues to rise.

While acute pain is generally considered a symptom of injury or illness, chronic pain that persists for long periods of time, or after an underlying injury or disease has resolved, is no longer merely a symptom. It is a specific healthcare problem, a condition in its own right, with unique physiological and psychosocial problems. Chronic pain places a tremendous burden on the sufferers quality of life, including:

Immobility, disability and inability to work

Disturbed sleep

Isolation, anxiety, frustration and depression

Poor appetite and nutrition

Increased susceptibility to disease

Devastating impact on attitude, lifestyle and behavior

Dependence on medication and long-term medical care

Adding to the health crisis, chronic pain is often associated with highly prevalent conditions such as diabetes, HIV/AIDS, cancer and depression. Furthermore, painful conditions associated with aging such as shingles, arthritis (joint pain), back pain, and muscle pain are often considered a normal, unavoidable part of aging. The time has come to educate sufferers, healthcare professionals and the public about chronic pain and the
need to reduce needless, prolonged suffering from persistent, debilitating pain.

A multidisciplinary group of specialists across Asia Pacific has convened to address the mounting problem of chronic pain in the region. Together this group, the Regional Chronic Pain Communications Council, has developed the first Asia Pacific Declaration for Chronic Pain Relief, a call to action to ultimately improve management and outcomes for people affected by this devastating condition.

The primary aims of the Declaration are twofold:

To raise awareness and elevate the profile of chronic pain as a condition in its own right, establishing chronic pain as a priority health issue in the minds of governments, healthcare professionals and the general public

To improve awareness and knowledge of chronic pain management among healthcare professionals to
help sufferers find relief across the Asia Pacific region

Chronic pain is a disease in its own right and should be considered a priority health concern across Asia Pacific. All patients deserve chronic relief to improve their quality of life; the following call to action has been developed by these leading experts in the Asia Pacific region:

Australia: Associate Prof Guy Bashford (Pain Specialist)

China: Dr Xuan Zhang (Rheumatologist)

Hong Kong: Dr Carina Li (Pain Specialist)

Korea: Prof Sangcheol Bae (Rheumatologist and Epidemiologist)

Malaysia: Prof Ramani Vijayan Sannasi (Anesthesiologist)

Philippines: Dr Henry Lu (Pain Specialist)

Singapore: Dr Alex Yeo (Pain Specialist)

Taiwan: Dr Lin Hsiao-Yi (Rheumatologist)

Thailand: Associate Prof Pradit Prateepavanich (Pain Specialist)

Asia Pacific Declaration for Chronic Pain Relief

1 ) Problem: The burden of chronic pain is considerable and yet chronic pain is still widely under-diagnosed and mismanaged in the Asia Pacific region. The International Association for the Study of Pain estimates that chronic pain affects one in five adults. As the population ages, chronic pain will become an increasingly important issue to address and carries a great economic burden. Chronic pain can greatly impair everyday
activities, social functions, quality of life and general well-being of sufferers; it can reduce the productivity of the workforce; and it places considerable demands on the healthcare system.

Call to Action:Recognize the personal, public and economic burden of chronic pain and establish chronic
pain as a priority public health concern in Asia Pacific.

2 ) Problem: Chronic pain, though usually associated with a chronic disorder, is pain that persists beyond resolution of an underlying disorder or injury. It is often more intense than the underlying cause would suggest. Currently, clinicians focus primarily on the diagnosis and treatment of the underlying disease or injury, reflecting the historical view that pain is simply a non-specific symptom of a disease process or injury. However, pain must be managed in the interest of the patients well-being and can occur due to changes within the nervous system or inflammatory response. Therefore, chronic pain treatment must target underlying neurological or inflammatory mechanisms. This suggests that chronic pain should be viewed as a condition in its own right.

Call to Action: Recognize that chronic pain should be seen as a condition in its own right by healthcare practitioners, policy makers and the public.

3 ) Problem: Chronic neuropathic and inflammatory pain are often under-diagnosed and mismanaged in the Asia Pacific region, leading to prolonged patient suffering and additional strain on the healthcare system. Often, pain is treated as a psychological problem rather than physiological condition. During training, physicians often receive limited education on the pathophysiology, clinical presentation, and treatment
options for chronic pain.

Call to Action: Improve the knowledge of chronic pain and its management among healthcare professionals in the Asia Pacific region with continuous medical education to ensure all patients receive appropriate diagnosis and management of pain. In addition, institutions need to ensure internal processes are in place to support improved chronic pain management.

4 )Problem: Chronic pain has a significantly negative impact on quality of life and can lead to great suffering, major disability, labor loss, and an extensive burden on the healthcare system. Sufferers of chronic pain often experience disturbed sleep, and may have co-existing disorders, such as anxiety and depression, all of which contribute to a reduction in quality of life. Often patients seek complementary treatments to treat these chronic pain conditions and avoid seeking advice from their physician.

Call to Action: Take chronic pain seriously by ensuring the effective treatment of chronic pain focuses on a holistic, evidence-based approach. Patients should be empowered to feel that they deserve to have chronic pain diagnosed and treated.

5 ) Problem: Chronic neuropathic pain is difficult for patients to describe and for doctors to diagnose. Unlike other forms of pain, neuropathic pain responds poorly, or not at all, to the standard analgesic drugs.

Call to Action: Improved strategies for articulating symptoms of neuropathic pain must be identified. Furthermore, new ways to manage and treat patients suffering from neuropathic pain must be utilized to reduce the significant impact of neuropathic pain on sufferers lives.

6 ) Problem: Musculoskeletal conditions are the most common cause of severe inflammatory pain and physical disability, and they affect hundreds of millions of people around the world. Both neuropathic and inflammatory chronic pain significantly affects the psychosocial status of affected people as well as their families and carers. Many musculoskeletal conditions are not reversible and the prevalence increases with age. Therefore, extending life expectancy and an aging population will result in greater numbers with chronic pain. Studies show that rheumatoid arthritis is equally as prevalent in Asian and Caucasian populations. The future impact of musculoskeletal and neuropathic conditions on individuals and society is likely to increase dramatically, particularly in less developed countries, leading to a dramatic increase in the chronic pain burden.

Call to Action: Educate the public to recognize neuropathic, musculoskeletal and inflammatory chronic pain symptoms and facilitate treatment access to help ease the burden of chronic pain.

7 ) Problem: To provide optimal pain relief for sufferers, current treatment strategies need to address the multi-factorial nature of chronic pain, including its heterogeneity and the presence of co-existing conditions. This requires a methodical approach to diagnosis, and a flexible, interdisciplinary approach to treatment. Both a healthy lifestyle and the right treatment programme should be initiated for sufferers of chronic pain.
Studies have shown that that regular exercise has advantages for patients with chronic pain to decrease fatigue and disability.

Call to Action: Improve the quality of life of chronic pain patients by establishing a multi-disciplinary approach to its diagnosis and management. Diagnose and treat chronic pain alongside co-existing conditions, underlying diseases, related syndromes and disabilities.

8 ) Problem: Many people in Asia Pacific unnecessarily endure debilitating chronic pain, often because they do not seek treatment; believe chronic pain is a natural part of growing older; or cannot articulate symptoms to their doctor. Many patients in Asia Pacific now search for information on the internet regarding chronic pain. Because the impact of the Internet on health care is expected to increase, physicians need to be prepared to help patients benefit from information obtained from the Internet.

Call to Action: Improve education for people affected by chronic pain. Develop more effective chronic pain educational resources and programs to empower sufferers to seek early diagnosis and treatment. Early diagnosis and treatment can reduce disability, pain and suffering.